North Region Research Articles

Classified Plant Al-Dhahiriya in the South of Palestine

We studied plant species of Dhahiriya in the period between January to October 2021, and January to Jun 2024, due to the importance of plants in that vital part of Palestine, which is located in southern Palestine, including that region’s climate, and unique plants that represent of the Mediterranean region plants, North Africa, Sinai desert, Negev, Dead Sea, and Red Sea. It used the Braun-Blanquet (1979) method for the identification of plants. Moreover, Plants have been studied in Dhahiriya, located in southern Palestine. A total of 770 species from 70 families were identified, of which 86 (11.16%) are endemic. The plant families with the highest representation were Asteraceae (14.54%), Fabaceae (14%), Poaceae (7.41%), and Lamiaceae (5.19%). Regarding plant life forms, Therophytes account for 47%, Hemicryptophytes for 20.35%, Shrubs or Chamaephytes for 14.05%, and Trees or Phanerophytes for 9.05%, with a notable increase in spring.

6.D. Skills building seminar: Family Vulnerability Scale: Why and how to use at Primary Health Care to promote health equity?

Abstract Family vulnerability encompasses multiple perspectives that are interconnected with the health needs of each family member. Families experiencing vulnerability face heightened risks of poor health outcomes. Nonetheless, these vulnerabilities are further compounded by systemic inequalities within healthcare systems, where biological or clinical factors are exclusively considered to organize and/or prioritize access, especially given the scarcity of valid instruments to measure family vulnerability. Primary Health Care (PHC) plays a pivotal role in addressing health inequalities, especially considering its bond with community. From this context, the Family Vulnerability Scale for Brazil (EVFAM-BR, in Portuguese) was developed and validated, been composed of 14 items about four dimensions (income, healthcare, family and violence) (2019-2023). By reducing the gap between science and practice, the implementation process of EVFAM-BR was started at the same year the scale was validated (2023). First, it occurred at 14 PHC services in São Paulo (Southeast Region, Brazil) and second, since 2024 has been implemented at Boa Vista (North Region, Brazil). Also, between 2024 and 2026, the implementation of EVFAM-BR is expected to take place in other Brazilian states participating in the third phase of the PlanificaSUS project, which is developed aiming to support State health departments to implement the Health Care Planning method to organize and integrate PHC and specialized outpatient care based on population health care needs. At this stage, capacity building is needed to align the concept of family vulnerability and to train PHC managers and health professionals on how to apply and use results from EVFAM-BR. This training has already been performed for around 1,000 health professionals from two different regions of Brazil, including managers, Community Health Workers, nurses, and physicians. The present workshop proposal aims to disseminate the EVFAM-BR and to offer the EVFAM-BR experience. It proposes knowledge transferring throughout participants engagement at three activities. Activity 1) “Family Vulnerability: From concept to a scale validity and application”: it is designed to engage participants to discuss about the family vulnerability concept and applicability at PHC, and to discuss on how EVFAM-BR implementation process has been occurring at Brazil and how can be tailored to other contexts. Activity 2) “Role Play: Practicing EVFAM-BR”: Two cases will be used for role play dynamics that will take place in trios, in which one will represent the community health worker, another will be the patient and the third will be the observer. Activity 3) That ones that assumed observer role will share their experiences of using EVFAM-BR. Finally, a discussion will be facilitated based on the participants’ impressions and a review of the main points covered throughout the workshop. Key messages • Family vulnerability stratification (through EVFAM-BR) is essential to plan services achieving equity and qualified population-based care management and to qualify patient approach and care. • Family Vulnerability Scale (EVFAM-BR) training represents efforts to reduce the gap between research and practice and contributes to address social determinants of health on healthcare.

LE GRAND BASCULEMENT DE LA VIOLENCE

The article is based on original maps produced using data from the Atlas of Violence published by the Institute for Applied Economic Research (Ipea) and the Brazilian Public Security Forum, showing huge spatial differences in the distribution of homicides. They associate the number of homicides recorded in each of the country's municipalities (represented by the size of the proportional circles) and the proportion of these homicides in relation to the municipal population (represented by a color gradation), while the background map is colored according to the municipal development index calculated by Firjan. The map drawn for the year 2021 confirms a clear evolution in relation to previous situations (1989, 1999, 2009 and 201), a shift in crime towards the Northeast and North regions, while the number and proportion of homicides in the population fell rapidly in the main capitals of the Southeast. Keywords: Violence, Movement, Crime.

EXPLORING CLIMATIC PATTERNS AMONG BRAZILIAN CAPITALS

This study aims to examine the patterns of climatic variables and delineate climatically homogeneous regions among Brazilian capitals using Principal Component Analysis (PCA) and clustering techniques. Annual climate data from 26 state capitals and the Federal District of Brazil were analyzed, covering the period from 1958 to 2022, representing different regions of the country. The PCA results revealed that the first three principal components accounted for 91.8% of the total data variability. Four climatically homogeneous regions were identified: the East region, the Northeast region, the North region and another region that comprises the rest of the country. Cluster Analysis (CA) also confirmed the formation of four homogeneous groups among municipalities based on climatic variables. The analysis of spatial distribution showed significant variations in annual climate variables between Brazilian capitals, with maximum values observed for maximum and minimum temperatures, precipitation, wind speed, relative humidity, evapotranspiration and soil moisture. These findings contribute to a deeper understanding of climate variability in Brazilian capitals and provide a basis for future studies on climate dynamics and regional impacts. Keywords: Principal Component Analysis, Cluster Analysis, Multivariate Analysis; Biplot

Family Vulnerability: From concept to a scale validity and application

Abstract This activity will last 20 minutes. An interactive presentation will be structured at three steps. First, a debate will be facilitated to engage participants on the following questions: i. What is family vulnerability? ii. Why should we measure family vulnerability at the context of Primary Health Care (PHC)? Second, once concepts are aligned, a brief presentation about the Vulnerability Family Scale for Brazil (EVFAM-BR) will be performed. At this time, participants will have the opportunity to know about the process of development, validation and the final version of EVFAM-BR (Souza et al., 2023, available at https://doi.org/10.1371/journal.pone.0280857). Third, presenters will share step by step how EVFAM-BR can be implemented into PHC, considering two real-world experiences in Brazil, Southeast and North regions, and will discuss about possible strategies to tailor it at different cultural and geographic context, from settings with higher vulnerability and low resources to high technology settings.

Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, 1990-2019

Abstract Background The double burden of malnutrition consists of the coexistence of nutritional deficiencies (malnutrition and overweight/obesity. Approximately 2.28 billion children and adults are overweight, and more than 150 million children are malnourished. The Decade of Action on UN Nutrition and SDGs that broaden the focus to both sides of malnutrition: overweight/obesity and nutritional deficiencies. Objectives To analyze the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. Methods: Study design This is an epidemiological time-series study. This study analyzed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardized mortality rate, and disability-adjusted life years (DALYs). This study also analyzed the correlation between the percentage variation of mortality rates and SDI. Results A decrease in the number of deaths (75%), mortality rate (75.1%), and DALYS (72%) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6%); however, the mortality rate (9.7) and DALYs (6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. Conclusions Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality. Key messages • Overcome the malnutrition public policies are necessary to guarantee the human right to healthy and sustainable food, such as encouraging the production and commercialization of fruits & vegetables. • Overcoming undernutrition and excess weight requires public policies aimed at reducing social inequality and providing access to healthy food for all, and taxation of ultra-processed foods.

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

Regional disparities and socio-demographic factors associated with eight or more antenatal care visits in Ghana

BackgroundAntenatal care is vital for maternal health and wellbeing, with the World Health Organization recommending a minimum of eight visits during pregnancy. In this study, we examined the regional disparities and factors associated with eight or more antenatal care visits in Ghana.MethodsWe performed a cross-sectional analysis of data from the 2022 Ghana Demographic and Health Survey. Our study comprised 3,893 women of reproductive age with birth history in the last two years before the survey. Regional disparities in the proportion of eight or more antenatal care visits were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was conducted to determine the factors associated with eight or more antenatal care visits using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of eight or more antenatal care visits in Ghana was 38.4% [95% CI = 36.0–41.0]. The regions with the highest prevalence were Eastern, Greater Accra, Western, and Volta. Those with the lowest prevalence were Northern, North East, Savannah, and Oti. The odds of eight or more antenatal care visits were lower among women aged 40–49 [aOR = 0.42, 95% CI = 0.18–0.96], women with four or more children [aOR = 0.57, 95% CI = 0.36–0.93], women who wanted pregnancy later [aOR = 0.63, 95% CI = 0.46–0.85], and women in five regions: Western North [aOR = 0.43, 95% CI = 0.19–0.94], Bono [aOR = 0.33, 95% CI = 0.14–0.76], Northern [aOR = 0.29, 95% CI = 0.13–0.66], Savannah [aOR = 0.30, 95% CI = 0.14–0.65] and North East [aOR = 0.33, 95% CI = 0.14–0.75]. Women in the richer [aOR = 1.99, 95% CI = 1.19–3.33] and richest [aOR = 4.82, 95% CI = 2.45–9.51] wealth index showed a higher likelihood of completing eight or more antenatal care visits relative to women in the poorest wealth index.ConclusionA significant proportion of women in Ghana fall short of the recommended eight or more antenatal care visits. Age, parity, desired pregnancy timing, wealth status, and region of residence are associated with the number of antenatal care visits. Women in five regions (Bono, Northern, North East, Savannah, and Western North) are significantly less likely to have eight or more antenatal care visits than those in the Western region. The government and policymakers should design programs to address the needs of older women, those with high parity, and women who want to delay pregnancy. Increased healthcare resources, educational campaigns, and addressing regional barriers to antenatal care access are crucial. Promoting public health initiatives to emphasise the importance of completing the recommended number of antenatal care visits for a healthy pregnancy is essential.

Unique regional risk profiles and cardiovascular outcomes of patients with acute coronary syndrome in the absence of standard modifiable risk factors: a systematic review and meta-analysis

Abstract Background With differences in prevalence, risk profile, cardiovascular complications, and mortality of patients with acute coronary syndrome (ACS) in the absence of standard modifiable risk factors (SMuRF-less) worldwide, this study examines the regional differences and the unique risk profiles of this often-understudied group of patients. Purpose We hypothesize that differences in non-traditional risk factor profiles may lead to unique ACS-related presentations, complication rates, and secondary preventative strategies across regions. Hence this study was undertaken to assess the cross-regional comparisons of patient characteristics, risk profile, angiographic characteristics that may provide insights into disparate cardiovascular outcomes observed in the SMuRF-less ACS population. Methods Medline and Embase databases were searched in November 2022 to identify relevant literature relating to the prevalence of risk factors in SMuRF-less patients with ACS. A single-arm meta-analysis of proportion and means was conducted on baseline and presentation characteristics, outcomes and complications, management, and risk factors in SMuRF-less ACS patients, stratified according to geographical region (Asia-Pacific, Europe, and North America). Risk of bias was assessed using the Newcastle-Ottawa scale. Results A total of 25 studies comprising of 1,393,184 individuals with ACS were included, of which 242,929 patients were SMuRF-less. Within this SMuRF-less ACS group, mortality rates were similar across the regions (Asia-Pacific:15.8%, Europe:17.5%, p=0.861), cardiac arrest (6.3%, 95%CI:2.3% to 16.3%, p=0.001) and major bleeding (5.2%, 95%CI:2.9% to 9.2%, p=0.001) were more prevalent in Asia-Pacific, and heart failure more common in Europe (21.7%, 95%CI:18.2% to 25.7%, p<0.001). Prevalence of chronic obstructive lung disease (21.4%, 95%CI:21.2% to 21.6%, p<0.001) and peripheral artery disease (3.8%, 95%CI:3.1% to 4.7%, p=0.001) were highest in SMuRF-less ACS patients from North America, chronic liver disease most prevalent in those from Asia-Pacific (3.5%, 95%CI:2.2% to 5.6%, p<0.001) and family history of coronary artery disease highest in SMuRF-less ACS patients from Europe (25.2%, 95%CI:24.8% to 25.7%, p=0.024). Significantly lower rates of guideline-directed medical therapy prescriptions were observed for SMuRF-less ACS patients in Asia-Pacific compared to other regions. Conclusion This regional analysis highlights the different risk profiles, cardiovascular outcomes, and specific needs of individuals presenting with ACS in the absence of cardiovascular risk factors, across Asia-Pacific, Europe, and North America. Whilst unravelling novel pathomechanistic pathways of atherosclerosis will prove beneficial on a global scale, understanding the unique regional profile of these individuals will aid policymakers strategize effective and tailored clinical pathways in the management of SMuRF-less ACS.Graphical AbstractKey Outcomes

Geographic inequities in hemodialysis access: a call to reassess dialysis facility locations in Brazil.

Patients who travel more than 60 min to undergo hemodialysis may experience higher mortality and lower quality of life. The primary aim of this study was to calculate the travel distance between patient city areas and dialysis facility care locations in Brazil, to highlight barriers and need to optimize access to chronic dialysis. We conducted a retrospective cohort study using claims data from the Brazilian Public Health System's database, focusing on kidney replacement therapy (KRT) by hemodialysis. Our study population comprised all patients undergoing hemodialysis in Brazil between January 2023 and December 2023. For patients from different city areas, we calculated the Haversine distance between the patient city area and the dialysis facility. We evaluated 154,788 patients who received hemodialysis funded by the Brazilian Public Health System. Fifty-nine percent of the patients underwent dialysis in the same city area. Overall, patients traveled a median (IQR) distance of 35.9 [19.5 - 64.2] kilometers to the facilities, 48% traveled more than 40 km, with a maximum traveling distance of 353 km. Notably, the median distance traveled was shortest in the Southeast (27.6 km) and longest in the North (84.3 km). The number of patients that traveled more than 40 km was lower in the Southeast (32%) and higher in the North region (77%). The travel distance to the dialysis facility is an important inequity to KRT access in Brazil. In the South and Southeast, where there is a higher dialysis unit density, patients have greater regional availability of dialysis centers, and shorter traveling distances than in the North, Midwest, and Northeast regions.

Morphology, pollen viability, and meiotic index of nance (Byrsonima cydoniifolia [A.] Juss)

Byrsonima cydoniifolia (nance), a forest species from the Malpighiaceae family, is widely distributed across Brazil, predominantly in the North, Northeast, and Central-West regions. This study aimed to analyze pollen morphology, viability, and the meiotic index in different native populations of nance in the eastern region of Mato Grosso state. For each population, five individuals were selected, and floral buds were collected during various developmental stages. The morphological characterization of pollen grains was conducted using the acetolysis protocol, followed by photography, measurement, and classification based on size, shape, ornamentation, and polar area index. The meiotic index was determined by counting post-meiotic products. Pollen grains were found to be spheroidal, small, 3-colporate, with a colpus, identified as tricolporate grains with a large polar area. The exine in the polar area was microreticulate. The meiotic index varied among populations and individuals, exceeding 95%. Pollen viability tests effectively distinguished between viable and non-viable pollen, with viability rates over 90%. The pollen grains contained starch and lipids as reserve substances. The species demonstrated high stability and meiotic regularity. The findings from this study contribute to our understanding of the ecology, conservation, dispersal, and propagation potential of nance, which supports the reproductive success of the species.

O ENGAJAMENTO DOS ESTUDANTES DE MEDICINA COM AS PRÁTICAS PROFILÁTICAS DO HIV

The human immunodeficiency virus (HIV) remains one of the main global public health challenges, with approximately 1.5 million new infections in 2021, despite the therapeutic advances that have transformed the prognosis of AIDS. In Brazil, HIV has an incidence rate of 17.69 cases per 100,000 inhabitants in 2020, with a significant increase among young people aged 13 to 29, especially in the North and Northeast regions. This cross-sectional study analyzed 50 medical students from a university in Brazil, investigating the association between age group and safe sex practices, such as the use of condoms, as well as the perception of vulnerability to HIV. The results indicate that 61.2% of the students used condoms during sexual relations in the last 12 months, with no significant correlation with age group (p=0.507). However, 50% of the students justified not using condoms because they trusted their partner, and 82% believed that they would be unlikely to be infected with HIV because of their social environment. Statistical analysis also showed that the perception of invulnerability to HIV does not vary significantly with age group (p=0.350). This study investigated risk perception and condom use among medical students, concluding that there is no significant correlation between age group and safe practices. Trust in the partner was a relevant factor in the non-use of condoms, highlighting the need for educational campaigns to promote preventive behaviors and awareness among future health professionals.

Occurrence and distribution of atrazine in groundwater from agricultural areas in China

There has been heavy application of chemical pesticides to farmland worldwide. As a state with a heavy emphasis on farming, China has extensively applied chemical pesticides to farmlands. Atrazine (ATZ), one of the most widely used herbicide in the world, has been used in large quantities in weed control in many crops, which poses a relatively large threat to groundwater utilization and agricultural safety. A nationwide sampling and analysis of ATZ in 8146 groundwater monitoring wells from 10 main grain producing areas were conducted during 2019. The results showed that the detection rate of ATZ in groundwater was 40.79 %, with detected concentrations up to 2.86 μg/L. ATZ detection rate was significantly higher in phreatic aquifers than confined aquifer. The concentration of ATZ decreased significantly with the depth increasing, the detected depth of ATZ in groundwater was varied from 5 to 1100 m, and 70.27 % of the detected ATZ was distributed in the depth of 0–51.8 m. The detection rate of ATZ in most north regions lower than south regions in China, and ATZ with high concentration was mainly occurred in southern regions. ATZ is more likely to migrate into the groundwater in the water resource rich areas. The concentration of ATZ decreased with TDS increasing, 74.39 % of the ATZ was detected in groundwater with TDS concentration <1 g/L. The hydrochemical type of groundwater in ATZ-enrichment environment were mainly Ca-HCO3 and Mixed type. According to classification and regression tree analysis, the high ATZ detection rate were closely related with groundwater depth (<51.8 m) and high organic matter content.

Restoring Degraded Lands in Maroua I Municipality, Cameroon: Application of Veazcomutech Techniques

This study was carried out in the Sudano-Sahelian zone of Cameroon. It aims to contribute to the restoration of degraded land in the localities of Maroua I; to set up a sustainable soil restoration technique based on Vetiveria zizanioide- Azadirachta indica-eggshell and Musa paradisiaca peel; to evaluate the restoration of this land through the crop set up and to assess the state of the art of the "VEACOMUTECH" technique on an area of 103.5 m2. The method envisaged in this research is based on the new modern technique "VEAZCOMUTECH): Technique of V. zizanioide, A. indica, Musa paradisiaca and eggshell" with a view to restoring the fertility of the land and diversifying the population's sources of income by using this technique. The study was carried out in the Maroua I municipality on experimental plots at the Technical School of Agriculture. A control plot and a main plot treated with VEAZCOMUTECH were selected. The most vigorous species were chosen to measure growth and yield parameters over a three-week period. The results of this study show that the application of "VEAZCOMUTECH" on the site increases plant growth. In the first week, leaf length ranged from six (06) to fifteen (15) centimetres on average in the control plot. In the main plot where "VEAZCOMUTECH" was applied, leaf length ranged from ten (10) to thirty-two (32) centimetres during the same week. By the third week, leaf length had increased from 15 to 20 centimetres, while in the main plot, leaf length had increased from 32 to 80 centimetres. There was also a clear difference in the number of leaves at week three, with 20 and 87 leaves for the control and main plots respectively. The largest number of flower buds (23 flower buds) was observed on the plant in the main plot, compared with 2 flower buds in the control plot. These results could serve as a reference for the strategy of restoration and fertilization of degraded land in the Far North Region in particular and in the Sudano-Sahelian zone in general.

Incidence and genetic risk of juvenile idiopathic arthritis in Norway by latitude.

We aimed to investigate the incidence of juvenile idiopathic arthritis (JIA) in the three geographical regions of Norway, and whether potential regional incidence differences are explained by environmental or genetic factors across regions. We conducted a register-based cohort study including all Norwegian children born 2004-2019, with follow-up throughout 2020. The JIA diagnosis defined by ≥ 2 ICD-10 codes for JIA was validated against medical records. The incidence rate (IR) and hazard ratio (HR) for JIA were estimated for all Norway, and for the regions North, Mid, and South. In a sub-sample from the Norwegian Mother, Father, and Child Cohort Study (MoBa), the genetic risk for JIA was assessed in the three regions. After median 9.1 (range 0.3-16.0) years of follow-up, we identified 1184 JIA cases and 910058 controls. The IR for JIA/100 000 person-years was 14.4 in all of Norway; 25.9 in region North, 17.9 in region Mid and 12.5 in region South. The HR (95% CI) of JIA in region North was 2.07 (1.77-2.43) and in region Mid 1.43 (1.23-1.67) compared to region South. Adjustments for perinatal factors, socioeconomic status, and early antibiotic exposure did not change our estimates substantially. In MoBa (238 cases, 57392 controls), the association between JIA and region of birth was no longer significant when adjusting for genetic factors. We found a higher incidence of JIA with increasing latitude, without evidence for available environmental factors explaining the observed gradient. In contrast, genetic factors modified the association, but further studies are warranted.

Emergency Preparedness for Waterborne Diseases in the Wake of Floods in Northern Cameroon: A Call for Immediate Action

Severe flooding in Northern Regions of Cameroon (Far North, North and Adamawa Regions), triggered by torrential rains, has led to widespread displacement, destruction of infrastructure, and significant disruptions in essential services, particularly water, sanitation, and healthcare. This article, issued by public health researchers from Science For Life Foundation and Pinnacle University Institute, highlights the heightened risk of waterborne diseases following the recent floods and underscores the urgent need for enhanced emergency preparedness and response measures. Floods create conditions conducive to the spread of diseases such as cholera, typhoid fever, dysentery, and viral hepatitis by contaminating drinking water supplies with sewage and waste. Vulnerable populations, including children, pregnant women, the elderly, and those with pre-existing health conditions, are at increased risk. Overcrowding in temporary shelters further exacerbates the potential for disease outbreaks. The impact of climate change is intensifying the frequency and severity of such flooding events, making timely and effective intervention critical. This article reviews best practices for preventing and mitigating waterborne disease outbreaks, offering guidance to government authorities, health agencies, humanitarian organizations, and local communities. It aims to catalyze immediate action to safeguard public health and prevent a major crisis in the aftermath of the flooding Keywords: Waterborne Diseases, Flooding, Emergency Preparedness.

Livestock Changes in Brazil and Sustainable Intensification Challenges

The increasing global demand for animal products has impacted Brazilian cattle farming. This study aims to offer references for developing more sustainable livestock farming in Brazil. It analyzes the numbers of pasture areas, cattle herds, and stocking rates from 1970 to 2017, based on agricultural census data. Additionally, it compares pasture conditions using agricultural census data and satellite imagery for the years 2006 and 2017. The key findings include the following: (1) a 119.7% increase in cattle herds, with migration from the South and Southeast to the North and Central–West regions, which have lower land prices; (2) a 2.6% decrease in the pasture area for cattle (except in the North region); (3) a 3.8% decrease in areas in poor condition; and (4) a 125.5% increase in the stocking rate. Despite technological advancements improving productivity, most pastures (59.6%) are still underperforming, indicating potential for reducing the pressure on native vegetation. This study concludes that production areas are shifting between regions in Brazil, with livestock farming intensifying, marked by a decrease in pasture areas and degraded pastures, alongside an increase in cattle numbers and stocking rates. However, these changes are heterogeneous across the country. This analysis provides an overview of beef cattle nationwide, which is relevant for addressing production sustainability challenges.

Response of the upper ocean to northeast Pacific atmospheric rivers under climate change

Atmospheric rivers are important transport vehicles for Earth’s water cycle. Using a high-resolution, eddy-resolving Earth System Model, atmospheric river impacts on the upper ocean are investigated by analyzing historical and climate change simulations. For atmospheric rivers along the North American coastline, strong winds cause significant dynamic and thermodynamic upper ocean responses. They push ocean water towards the coast, measured by sea surface height, a process that is amplified under climate change. Mixed layers are deeper upstream of atmospheric rivers, and shallower downstream, however for climate change, shoaling downstream is subdued. Air-sea heat fluxes tend to promote ocean cooling upstream and warming downstream, although different regions have different climate change heat flux signals. Southern California heat flux changes due to warming are driven by evaporative processes and strengthen the ocean responses seen in historical simulations. The regions north are primarily dominated by sensible heat flux changes and counter the historical patterns.

Temporal trends, spatial and spatiotemporal clusters of cervical cancer mortality in Brazil from 2000 to 2021

Cervical cancer, despite being preventable through primary and secondary prevention strategies, remains one of the leading causes of morbidity and mortality among women in Brazil. This study aimed to analyze the temporal, spatial, and space-time patterns of cervical cancer mortality in Brazil. An ecological study was conducted using temporal, spatial, and space-time analysis techniques, using death certificates with cervical cancer as the underlying cause or associated condition among females in Brazil from 2000 to 2021. Death certificate and population data were provided by the Department of Health Informatics of the Unified Health System (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE), respectively. A total of 123,306 deaths associated with cervical cancer among women were registered during the study period. A rising trend in mortality was detected since 2014 onwards, after 14 years of decline. Particularly, an increase in mortality was observed among the younger age groups, and in the North and Northeast regions regardless of age. Heterogeneity in the spatial distribution of cervical cancer mortality was observed, with high mortality clusters around the country, but mostly concentrated in the North and Northeast regions. These findings suggest a need and an opportunity to develop efficient and effective health policies targeting those regions and groups of women at higher risk which in turn will allow for fast and significant reductions in cervical cancer mortality in Brazil.

Molecular Epidemiology of Pseudomonas aeruginosa in Brazil: A Systematic Review and Meta-Analysis.

Globally, Pseudomonas aeruginosa is a high-priority opportunistic pathogen which displays several intrinsic and acquired antimicrobial resistance (AMR) mechanisms, leading to challenging treatments and mortality of patients. Moreover, its wide virulence arsenal, particularly the type III secretion system (T3SS) exoU+ virulotype, plays a crucial role in pathogenicity and poor outcome of infections. In depth insights into the molecular epidemiology of P. aeruginosa, especially the prevalence of high-risk clones (HRCs), are crucial for the comprehension of virulence and AMR features and their dissemination among distinct strains. This study aims to evaluate the prevalence and distribution of HRCs and non-HRCs among Brazilian isolates of P. aeruginosa. A systematic review and meta-analysis were conducted on studies published between 2011 and 2023, focusing on the prevalence of P. aeruginosa clones determined by multilocus sequence typing (MLST) in Brazil. Data were extracted from retrospective cross-sectional and case-control studies, encompassing clinical and non-clinical samples. The analysis included calculating the prevalence rates of various sequence types (STs) and assessing the regional variability in the distribution of HRCs and non-HRCs. A total of 872 samples were analyzed within all studies, of which 298 (34.17%) were MLST typed, identifying 78 unique STs. HRCs accounted for 48.90% of the MLST-typed isolates, with ST277 being the most prevalent (100/298-33.55%), followed by ST244 (29/298-9.73%), ST235 (13/298-4.36%), ST111 (2/298-0.67%), and ST357 (2/298-0.67%). Significant regional variability was observed, with the Southeast region showing a high prevalence of ST277, while the North region shows a high prevalence of MLST-typed samples and HRCs. Finally, this systematic review and meta-analysis highlight the role of P. aeruginosa clones in critical issue of AMR in P. aeruginosa in Brazil and the need of integration of comprehensive data from individual studies.